How much improvement in patient reported outcomes after isolated medial patellofemoral ligament reconstruction is associated with surgeon-defined satisfactory outcomes? A JUPITER study
Saral Patel MD , Matthew W. Veerkamp BA , Eric J. Wall MD , Philip L. Wilson MD , Daniel W. Green MD, MS, FAAP, FACS , Benton E. Heyworth MD , Natalie K. Pahapill BS , Beth E. Shubin Stein MD , Shital N. Parikh MD, FACS
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Abstract
Introduction
The extent of change in Patient Reported Outcome Measures (PROMs) required to meet surgeon-defined satisfactory outcomes after isolated medial patellofemoral ligament reconstruction (MPFL-R) has not been reported. The primary aim of the study was to define the threshold value of maximal outcome improvement (MOI) in PROMs associated with surgeon-defined satisfactory postoperative outcomes. The secondary aim was to identify the most effective PROM in predicting these outcomes and to evaluate the factors associated with it.
Methods
This is a retrospective review of prospectively collected data as part of the JUPITER multi-center study. Receiver operating characteristic curves were calculated to determine threshold values for MOI for 4 commonly used PROMs - Banff Patella Instability Instrument (BPII 2.0), Pediatric International Knee Documentation Committee (Pedi-IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS) and Kujala score - associated with surgeon-defined satisfactory outcomes. Multivariate analyses were performed to determine preoperative, intraoperative, and radiographic factors associated with satisfactory outcomes.
Results
284 patients were included in the analysis. 183 (66.9 %) patients achieved surgeon-defined satisfactory outcomes. For MOI, achieving an improvement in BPII 2.0 score greater than 65.86 % (Area under the curve (AUC): 0.75; CI: 068–0.80; p < 0.0001) and in the Kujala score greater than 85.18 % (AUC: 0.69; CI: 0.62–0.75; p < 0.0001) was associated with a satisfactory outcome. BPII 2.0 had the highest AUC while Kujala had the least AUC (p = 0.04). Multiple logistic regression analysis showed that first-time dislocation or having 10 or more dislocations prior to surgery significantly decreased the odds of achieving satisfactory postoperative outcomes (OR 0.12, p = 0.002). None of the radiographic parameters were associated with outcomes.
Conclusion
MOI serves as an important measure to gauge clinical success after isolated MPFL-R. The study sets MOI thresholds for four commonly used PROMs, thus correlating patient- and surgeon-defined satisfactory outcomes after isolated MPFL-R. BPII 2.0 had good discriminative ability while Kujala had the least. The study identifies that isolated MPFL-R after first-time dislocation or after 10 or more dislocations are associated with decreased odds of satisfactory outcomes.
Level of evidence
Level 4 retrospective review of prospectively collected data.